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Updated: May 7, 2026

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An algorithmic approach to mechanical hip pain.

Lazaros A Poultsides1, Asheesh Bedi, Bryan T Kelly

  • 1Department of Orthopaedic Surgery, Center for Hip Pain and Preservation, Hospital for Special Surgery, 535 East 70th street, New York, NY 10021 USA.

HSS Journal : the Musculoskeletal Journal of Hospital for Special Surgery
|October 2, 2013
PubMed
Summary

An algorithmic approach and layered diagnosis improve the identification and treatment of hip pain. This systematic method enhances understanding of intra- and extra-articular hip disorders for better patient outcomes.

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Area of Science:

  • Orthopedics
  • Sports Medicine
  • Physical Therapy

Background:

  • Evolving understanding of hip pathology necessitates earlier identification.
  • Distinguishing intra-articular from extra-articular hip pathology is crucial at all patient encounter stages.
  • Accurate diagnosis of hip pain requires a systematic approach.

Purpose of the Study:

  • To evaluate if an algorithmic physical examination improves diagnosis and treatment of painful non-arthritic hips.
  • To determine if an anatomical layered diagnostic concept enhances diagnostic accuracy.
  • To identify essential diagnostic tools for a four-layer hip diagnosis (osteochondral, inert, contractile, neuromechanical).

Main Methods:

  • Conducted an unrestricted computerized MEDLINE search.
Keywords:
extra-articular hip pathologyhip painintra-articular hip pathologymechanical hip painphysical examination of the hip joint

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  • Utilized various search terms in combination.

    • Main Results:

    • An algorithmic approach, incorporating history, physical examination, and advanced imaging, aids in interpreting intra- and extra-articular hip disorders.
    • This method improves understanding of how abnormal joint mechanics contribute to hip pathology and asymmetric loading.
    • The four-layer concept (kinematics, cartilage/labrum, musculotendinous, neural) systematically identifies the source of hip pain and guides treatment.

    Conclusions:

    • A systematic physical examination and diagnostic imaging assessment are key to understanding hip pain.
    • Recognizing how mechanical factors cause compensatory injuries facilitates diagnosis and treatment recommendations.
    • The layered diagnostic approach provides a framework for managing complex hip pathologies.